Pharm for final

Question 1

Dexmedetomidine - indications

Answer 1

• Licensed for sedation of critical care patients
• Also used in anaesthetic practice…
• Opioid sparing e.g. in bariatric
• Awake craniotomy
• Awake fibreoptic intubation

Question 2

Dexmedetomidine - dose

Answer 2

Loading dose of 1mcg/kg
Infusion of 0.2-0.7mcg/kg/hr

Question 3

Pre-medication drugs/doses. MIDAZOLAM

Answer 3

Used in kids. Up to 20mg dose usually.

Oral/buccal 0.5mg/kg (nb unpleasant taste)
Intranasal 0.2mg/kg (nb stings)

Quick onset 10-20mins

Question 4

Pre-medication drugs/doses. TEMAZEPAM

Answer 4

Oral 10-30mg tablets

Onset 45-60mins

Question 5

Pre-medication drugs/doses. KETAMINE

Answer 5

Oral 5-10mg/kg. Onset 10-20mins
Intranasal 3-5mg/kg
Intramuscular 5mg/kg, onset 3-5mins

Question 6

Pre-medication drugs/doses. CLONIDINE

Answer 6

Oral 4mcg/kg, 45-60mins to take effect, last 6hrs

Question 7

How might you set up a TIVA pump in obese patient?

Answer 7

Servin formula. INPUT the following mass

IBW + 0.4 x (ABW-IBW)

Question 8

How does heparin work?

Answer 8

Has no DIRECT anticoagulant effect
Potentiates activity of antithrombin III
Protease inhibitor that irreversibly binds thrombin and factor Xa

Question 9

Causes of heparin resistance?

Answer 9

1. Due to AT III deficiency
2. Increased heparin clearance
3. High factor VIII levels
4. Elevated heparin-binding proteins

Causes of antithrombin III deficiency?
Congenital - autosomal dominant antithrombin III deficiency
Acquired
- Reduced ATIII synthesis: liver failure, warfarin therapy
- Renal loss: nephrotic syndrome, renal f.
- DIC

Question 10

How to treat ATIII deficiency?

Answer 10

Recombinant ATIII
FFP

Question 11

Esmolol dose?

Answer 11

0.25-0.5mg/kg bolus, follow up with metoprolol